Section 3902 - Declaration of policyThe General Assembly finds and declares as follows:
(1) Phenylketonuria (PKU), branched-chain ketonuria, galactosemia and homocystinuria are aminoacidopathies that are rare hereditary genetic metabolic disorders.(2) Lacking in these aminoacidopathies is the body's ability to process or metabolize amino acids, and, if left untreated or without proper therapeutic management, these disorders cause severe mental retardation and chronic physical disabilities.(3) The only form of treatment is by restricting food intake in order to remove the problem amino acids, which are necessary in the diet, and then replenishing them in carefully controlled measured amounts of a nutritional food substitute.(4) In an attempt to encourage the development of new products, increase availability and reduce cost, formulas were removed from the Federal prescription list and reclassified as medical foods. An unfortunate side effect has been the reluctance of many insurance companies to cover the cost of these formulas. In instances where coverage is provided, it is random and subject to inconsistent interpretation.(5) The intent of this legislation is not to require insurance coverage for normal food products used in dietary management of these disorders, but to provide for such coverage of formulas that are equivalent to a prescription drug medically necessary for the therapeutic treatment of such rare hereditary genetic metabolic disorders and administered under the direction of a physician.(6) In recognition by the General Assembly that such formulas are medically necessary and critical to the well-being of individuals afflicted with rare hereditary genetic metabolic disorders, it shall be required that health insurance policies issued in this Commonwealth shall include such coverage.1996, Dec. 20, P.L. 1492, No. 191, § 2, effective 6/20/1997.